Augmented surgical interface

ABSTRACT

The present invention is a system comprising surgical units and operator interface units configured to provide multiple capabilities within a surgical environment, or within a surgical training environment. The system may provide such capabilities in a modular fashion, such that various functions may be accomplished through the addition or deletion of modules to the system to allow core components to be used to accomplish more than one function.

RELATED APPLICATIONS

This patent application is a non-provisional application and claimspriority from U.S. Provisional Patent Application Ser. No. 60/617,864,filed Oct. 12, 2004, and from U.S. patent application Ser. No.10/652,722, filed on Dec. 17, 2003, the entire disclosures of which areincorporated by reference herein as if being set forth in theirentireties, respectively.

FIELD OF THE INVENTION

The present invention relates to the field of robotic and computerassisted surgery, and more specifically to equipment and methods forrobotic and computer assisted microsurgery.

BACKGROUND

As shown in U.S. Patent 5,943,914 to Morimoto et al., “Master/slave”robots are known in which a surgeon's hand input is converted to arobotic movement. This is particularly useful for motion scaling whereina larger motion in millimeters or centimeters by the surgeon's input isscaled into a smaller micron movement. Motion scaling has also beenapplied in cardiac endoscopy, and neurosurgical target acquisition brainbiopsy (with a needle) but only in one degree of freedom, for exampleonly for insertion, not for a full range of natural hand movementdirections, i.e., not for all possible degrees of natural motion,Cartesian, spherical or polar coordinate systems or other coordinatesystems.

Further, in the prior art, surgical robots have been purposefullydesigned to eliminate the natural hand tremor motions of a surgeon'shand which is about a 50 micron tremor which oscillates with someregularity. The common presumption is that tremor motion createsinaccuracies in surgery. Therefore, robots have been tested whichentirely eliminate the surgeon's natural hand tremor. See “A Steady-HandRobotic System for Microsurgical Augmentation” Taylor et al.,International Journal Of Robotics Research, 18(12):1201-1210 Dec. 1999,and also see “Robotic-assisted Microsurgery: A Feasibility Study in theRat” LeRoux et al., Neurosurgery, Mar. 2001, Volume 48, Number 3, page584

The way the primate body handles proprioceptive perception is viasensory feedback scaling (up and down) at the muscular level through theintrafusal fiber system of the Gamma efferent neural circuit. Thissystem responds dynamically to changes in the anticipated muscleperformance requirement at any instance by adjusting muscle tone withincreased discharging for arousal and attention focusing states, anddecrease output for resting and low attention states. The muscle spindleapparatus that does this is located in the muscle body, thereforefeedback sensory scaling for muscle positioning, force, length andacceleration is partly programmed at the effector level in “hardware” ofthe body, i.e., the muscle itself. The evidence indicates a 10 cycle persecond refresh rate for the human neurophysiological system in general.

Joint position and fine motor function of the fingers occurs throughunidirectional (50% of fibers) and bi-directional (50% of fibers)sensing at the joint structure. This coding is for rotation about anaxis, but not for force and no clear speed of rotation feedback.

Cutaneous receptors in the skin code for motion, by modulating highercenters in the thalamus and cerebral cortex. This can be timed to about75 ms delays before motion occurs, including three neuronal synaptictransmission delays. These sensors are primarily distal to the joint ofrotation and distal in the moving effector limb. Finally, the sense ofcontact is totally discrete from the above motion feedback sensorysystems and the neural pathways and integration centers in the deephemispheres and cerebral cortices function independent of motion to alarge degree.

Force reflectance sensing is also known in order to provide tactile orhaptic feedback to a surgeon via an interface. See “Connecting HapticInterface with a Robot” Bardofer et al., Melecon 200—10^(th)Mediterranean Electrotechnical Conference, May 29-31 2000, Cyprus.

However, in testing, all of these techniques ultimately slow down theactual surgery especially when performed in conjunction with amicroscope for viewing the operation. The procedure time is typicallyincreased by two to three times. See Robotic-assisted Microsurgery: AFeasibility Study in the Rat” cited above. It is believed that thisaffect is related to cognitive, perceptive and physiologic discrepanciesbetween a surgeons expectations and the feedback and motions of asurgical robot in use.

Another major design issue regards the choice between locating thesurgeon in his normal operating position adjacent to the surgical fieldor locating the surgeon more remotely from the normal operating positionat a terminal with a joystick and viewing screen for example. The priorart elects to locate the surgeon remotely from the traditionaloperational position about the head and to use monitors to display theoperation to the surgeon.

SUMMARY OF THE INVENTION

A system comprising surgical units and operator interface unitsconfigured to provide multiple capabilities within a surgicalenvironment, or within a surgical training environment, is described.The system may provide such capabilities in a modular fashion, such thatvarious functions may be accomplished through the addition or deletionof modules to the system to allow core components to be used toaccomplish more than one function.

An augmented surgical appliance is also described. The applianceincludes a surgical unit, a controller unit for controlling the surgicalunit, and at least a first and a second interface unit, the first andsecond interface units providing force feedback signals to operators ofthe interface units, where the first and said second interface units arecommunicably connected to the controller. The surgical unit iscommunicably connected to the controller, where the controller includessoftware for transferring control of the surgical unit from the firstinterface unit to the second interface unit upon receipt of anindication by an operator of the second interface unit that control ofthe surgical unit should be transferred from the first interface unit tothe second interface unit.

Further described is a method for utilizing such an augmented surgicalappliance. The method includes the steps of communicably connecting thefirst and second interface units to the controller, communicablyconnecting the surgical unit to the controller, transferring control ofthe surgical unit to the first interface unit, initiating a surgicalprocedure utilizing the surgical unit, receiving from an operator of thesecond interface an instruction to transfer control of the surgical unitfrom the first interface unit to the second interface unit, transferringcontrol of the surgical unit to the second interface unit when aninstruction to transfer control of the surgical unit from the firstinterface unit to the second interface unit is received, and continuingthe surgical procedure.

Additionally, a computer readable media, which when executed by acomputer implements a process providing control functionality to anaugmented surgical appliance, is described. The process includes thesteps of transferring control of the surgical unit to the first operatorinterface unit, receiving from an operator of the second operatorinterface unit an instruction to transfer control of the surgical unitfrom the first operator interface unit to the second operator interfaceunit, transferring control of the surgical unit to said second operatorinterface unit when an instruction to transfer control of the surgicalunit from the first operator interface unit to the second operatorinterface unit is received, and continuing the surgical procedure.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 illustrates an augmented surgical interface according to thepresent invention, wherein two operator interface units are provided toalternately control a single augmented surgical unit.

FIG. 2 is a notional process flowchart associated with a process forcontrolling the system of FIG. 1.

FIG. 3 illustrates an augmented surgical interface system according tothe present invention, wherein two augmented surgical units arecontrolled concurrently by a single operator interface unit.

FIG. 4 illustrates a notional process flowchart associated with aprocess for controlling the system of FIG. 3.

FIG. 5 illustrates an augmented surgical interface system according tothe present invention, wherein a plurality of repeater interfaces areprovided to allow operators in training to follow through a surgicalprocedure in process.

FIG. 6 illustrates an augmented surgical interface system configured toprovide a simulated surgical procedure, wherein the system includes asimulation generator, a first interface unit, a second interface unit,and repeater interface unit.

FIG. 7 illustrates an augmented surgical interface system according tothe present invention, wherein two operator interface units are providedto concurrently control two augmented surgical units via a controllerincorporating functionality to deconflict motions of effectorsassociated with the surgical units.

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to an augmented surgical appliance, usingan operator interface 102 for a surgeon 104 combined with an augmentedsurgical unit portion 106 for performing surgical procedures. Theinterface and surgical unit portions are interconnected via a controller108, which receives input from the interface 102, and converts the inputto output performed by the surgical unit 106. Feedback is provided tothe interface 102 from the controller 108 in response to parametersmeasured at the surgical unit 106.

As shown in FIG. 1, the controller may be provided with a plurality ofcommunications ports 110 for receiving input from one or more interfaces102, 112. The controller 108 may also be provided with one or morecontrol ports 114 for providing control signals to the surgical unit106. As shown in FIG. 1, a single surgical unit 106 may be controlled bya plurality of interface unites 102, 112, where the controller includesfunctionality for integrating the inputs from the multiple interfaceunits 102, 112 in a coordinated fashion so as to prevent inadvertentsignals being transmitted to the surgical unite 106.

In the embodiment as shown in FIG. 1, a single surgical unit 106 may beconnected to a control port 114 associated with the controller 108,while an instructor interface 102 and a student interface 112 areconnected to communications ports 110 associated with the controller108.

Such a system embodiment allows the instructor interface 102 to providean instructor 104 to closely observe a surgical procedure, and assumecontrol of the surgical unit 106 either for safety or instructionalpurposes. Such a process is shown in FIG. 2, wherein an instructorinterface and a student interface have been provided 202, 204 inconjunction with a single surgical unit positioned 206 in the surgicalfield. At the start 212 of the surgical procedure, control of thesurgical unit may be transferred 214 to the student interface.

As the surgical procedure proceeds, the instructor may monitor 216 theprocedure. If the instructor determines 220 that an over-ride of thestudent control of the surgical unit is indicated, the instructor mayrequest 220 control of the surgical unit. The transfer may either be atransfer of motion control, may cause a suspension of further motion bylocking the motion of the surgical unit, or may cause the surgical unitto translate any tools in use to a safe position.

As it may be desirable to alternately freeze an instrument in position,hold an instrument in an as deployed condition, or cause the instrumentto retract to a safe position, it may first be determined 222 whetherthe instructor desires the instrument to be retracted. If the instructordesires the instrument to be retracted, the controller may command 224retraction of the instrument to a safe position. If the instructor doesnot desire to have the instrument retracted, it may then be determined228 whether the instructor desires the instrument to be held in place.If the instructor desires the instrument to be held in place, thecontroller may command 230 that the instrument be held at a locationuntil released by the instructor. Additionally, where an instrument isbeing held in place 230, it may be determined 232 whether the instrumentshould be fixed as to condition (i.e., open or closed for a forceps),and if it is determined that it is desired to fix the instrument in acondition, the controller may command 234 that the instrument be fixedas to condition until released to the operator. Once the transferparameters have been determined and commanded by the controller, controlof the surgical unit may be transferred 236 to the instructor. Thisdetermination of transfer parameters may be extended to multipleeffectors/instruments in use, i.e., parameters may be obtained for bothan effector associated with a right hand control and for an effectorassociated with a left hand control. Transfer parameters may also bepreconfigured, such as should an instructor require a rapid transfer ofcontrol, the instruments/effectors could be preconfigured to transfer asfree, to a retracted position, to a hold position, and/or a fixedcondition.

The procedure may continue with the instructor in control until theinstructor determines 240 that control should be transferred back to thestudent, at which point control may be transferred 214 to the student.Such transfer may additionally implement retraction of instruments inuse, position hold for instruments in use, and a condition fix forinstruments in use.

As shown in FIG. 3, the system may be configured in the operating roomto include two surgical units 302, 304, associated with a singleinterface unit 306 via a controller 308. The interface unit 306 maytypically have two hand controllers 3310, 312, corresponding to the leftand right hands (not shown) of an operator 314. The surgical units 302,304 may typically have more than one effector 316 per surgical unit 302,304 (two effectors per unit are shown), such that an operator 314 hasfour (4) possible effectors to control from two hand controllers 310,312. The use of multiple effectors allows a larger tool set to beavailable to the operator 314.

As shown in FIG. 4, the use of a greater number of effectors than handcontrollers may be accomplished using the illustrated process. Thesurgical environment may be provided with an inter unit 406, as well asbe provided 402, 404 with first and second surgical units. The interfaceand surgical units may be communicably connected 410 to a controller.Control of the surgical units may be transferred 412 to the interface,at which point the operator may select 414 effectors and associate themwith hand controllers. For example, an effector on the first surgicalunit may be associated with the right hand controller, while an effectorassociated with the second surgical unit may be associated with the lefthand controller. Such association may not only provide control authorityover the given effector by a selected hand controller, it may also causethe controller to apply feedback parameters associated with the selectedeffector to the hand controller.

Once the desired effector and hand controller associations have beenselected 414, the surgical procedure may be initiated 416. If theoperator determines 422 during the procedure that different effectorassignments are desired (i.e., use of a new effector or re-assignment ofan effector in use to a different hand controller is desired) theoperator may identify 426 the new effector/hand control assignment tothe controller.

The position and condition of the effector will typically be ofsignificance, such as where a tool for retracting flesh is beingdeselected. If the retractor were erroneously retracted, it could causecomplications of the surgical procedure. Accordingly, it may bedesirable to fix the effector in a position to allow a tool in use onthe effector to remain in use after the effector is deselected.Alternately, it may be desirable to have the tool automaticallyretracted to a position outside of the surgical field. The surgeonoperating the interface may thus indicate which response is desired.Additionally, where tools may have multiple degrees of freedom, such asa forcep tool having both position and clamping conditions, the operatormay further indicate whether it is desired that the tool remain in theadditional conditions, such as clamped or unclamped for a forcep tool.Again, the transfer condition of an instrument may be defined by theoperator. If it is determined 426 that the operator desires aneffector/instrument to be retracted prior to the transfer,effector/instrument may be retracted 428. If it is determined 430 thatthe operator desires that a de-selected effector/instrument be held inposition, the controller may issue commands to hold 423 theeffector/instrument in position. Finally, if it is determined 434 thatthe operator desires that an effector/instrument be fixed as tocondition, the controller may issue commands to fix the instrument in agiven condition. Holding an instrument in position may be included whenan effector/instrument is fixed as to position. If neither retract,hold, and/or fix as indicated, the operator may be queried to determinewhich condition the de-selected instrument should be left in. Once thecondition of the deselected effector/instrument has been determined andaccomplished, control of a selected effector/instrument may be assigned440 to an identified control handle, and the surgical procedure maycontinue.

Although the flowchart illustrates only a single cycle of a neweffector/hand controller assignment occurring, it is contemplated thatmultiple reassignments may occur during a single surgical procedure.

As shown in FIG. 5, the augmented surgical interface system may furtherbe implemented to allow one or more operators in training 502, 504, 506to follow through a surgical procedure being performed by a firstsurgeon 508. The surgeon 508 may be provided with an interface unit 510connected to a controller 512. A surgical unit 514 having one or moreeffectors 516 may additionally be connected to the controller.

Repeater interfaces 518, 520, 522 may be provided to allow operators intraining 502, 504, 506 to follow through as the first surgeon 508performs a procedure. In such a situation, the repeater interfaces wouldnot have control authority over the surgical unit 514, however wouldreceive display and feedback parameters from the controller 512, suchthat control handles 524 on the repeater interfaces 518, 520, 522 wouldmirror the positioning of the control handles 526 on the operatorinterface 510. Accordingly, the feedback systems utilized in theinterface units as described previously would cause the control handles524 to mirror the motions of the first surgeon's control handles 526.Additionally, the provision of display units 528 on the repeaterinterfaces 518, 520, 522 would allow the operators in training 502, 504,506 to also see the visual presentations being provided to the firstsurgeon 508.

The repeater interfaces 518, 520, 522 may be the same as the interfaceunit 510, with the controller 512 being used to prevent the repeaterinterfaces 518, 520, 522 from having any control authority over thesurgical unit 514. The use of common interface units may reduce the costof implementing such a system on a hospital, such that where a hospitalprocures surgical units for more than one operating theater, theassociated interface units may be aggregated in a single operatingtheater for a procedure which is to be followed through by operators intraining, without the hospital having to procure additional equipment.

As shown in FIG. 6, the modular nature of the controller 604, surgicalunit, and interface units also lend themselves to aggregation to form asimulator system 600. A simulation generator 602 may be connected to acontroller 604. The simulation generator 602 may be provided with anenvironment model 606 for defining expected responses as a tool moveswithin a simulated surgical field. Such an environment model 606 mayinclude parameters defining tissue position and consistency, as well astissue response parameters to various surgical instruments which may beencountered during a simulated surgical procedure. The simulationgenerator 602 may further be provided with a display generator 608 forgenerating a simulated display of the surgical field, including tissueand tool positioning, as well as indicators and feedback that would beprovided to a surgeon during a procedure.

Finally, the simulation generator may further be provided with akinematics model 610 that models the kinematic response of surgicalinstruments within the surgical field, such as contact information,acceleration forces and other motion forces which would be encounteredduring an actual procedure. The output of the simulation generator maybe provided to the controller, such that the controller is provided withsignals which would be consistent with the signals transmitted to thecontroller during an actual procedure. A first interface unit 612 may bedesignated as the controlling interface unit, such that commandsprovided by an operator 614 of the first interface unit would be used toprovide command parameters for a simulated surgical procedure. A secondinterface unit 616 could be provided for a supervising surgeon oroperator 618, such that the training system of FIG. 1 could beimplemented in a simulated environment, such as may be desired tofamiliarize an operator in training 620 with the hand off procedures.

Finally, a third interface unit 622 may also be provided to allow asecond operator in training 624 to follow though the simulatedprocedure, or to step in upon the directions of the supervising surgeonor operator 618. The third interface may alternately be limited suchthat control authority could not be transferred to the third interfaceunit 622, effectively rendering the third interface unit to be arepeater interface unit.

As shown in FIG. 7, it may be desired to utilize multiple surgical units702, 704 in conjunction with multiple interface units 706, 708 during asurgical procedure. In such a situation, the ability to preventinterference between instruments associated with the different surgicalunits 702, 704 may be of paramount importance.

The position of tools within the surgical field may be modeled as afunction of the position of the surgical units to a fixed reference,such as the surgical table. The use of such referencing was discussedpreviously. By indexing both surgical units 702, 704 to the surgicaltable 710, the resultant position of the surgical instruments could bedetermined by the controller 712 as a function of the position of theeffectors to which the instruments are attached, as well aspredetermined knowledge of the instruments themselves.

Although the position of the tools is important in preventinginterference between the tools, predictive analysis of the motion of theinstruments themselves may provide a more effective function for theoperators. The projected position of the tools may be based on thepresent motion and speed of the instruments, such that an increasingvalue can be determined indicating the likelihood of interferencebetween the instruments. Such a value may be increased the sooner aninterference may occur, i.e., a likely interference that will not occurfor a longer period of time will be assigned a lower value than a likelyinterference which will occur sooner.

An indication of the likelihood of contact may be presented to one orboth of the operators during a procedure with multiple interface units.The indicator may be a visual or audible warning to the operators.Alternately, the controller may impose a scale function to the motion ofthe instruments as a function of the likelihood of the interference. Forexample, a velocity component of a commanded motion of an instrument maybe reduced by an increasing factor the higher the likelihood of aninterference. Thus, minimal scaling of the motion command would occurwhere the interference was of a lower likelihood, i.e., not expected tooccur for a given amount of time. As the likelihood of the interferenceis expected to occur sooner, the scaling of the motion command may beincreased to further slow the motion of the instrument, thus reducingthe likelihood of an interference, as well as signaling the operator ofthe likelihood of the interference.

Other variations and modifications of the present invention will beapparent to those of skill in the art, and it is the intent of theappended claims that such variations and modifications be covered. Theparticular values and configurations discussed above can be varied andare cited merely to illustrate a particular embodiment of the presentinvention and are not intended to limit the scope of the invention. Itis contemplated that the use of the present invention can involvecomponents having different characteristics as long as the principles ofthe invention are followed.

1. An augmented surgical appliance comprising: a surgical unit; acontroller unit for controlling said surgical unit; and at least a firstand a second interface unit, said first and second interface unitsproviding force feedback signals to operators of said interface units,wherein said first and said second interface units are communicablyconnected to said controller; wherein said surgical unit is communicablyconnected to said controller; and wherein said controller comprisessoftware for transferring control of said surgical unit from said firstinterface unit to said second interface unit upon receipt of anindication by an operator of said second interface unit that control ofsaid surgical unit should be transferred from said first interface unitto said second interface unit.
 2. An augmented surgical applianceaccording to claim 1, wherein said controller comprises software formoving an effector and/or instrument associated with said surgical unitto a retracted position upon receipt of an indication by an operator ofsaid second interface unit that the effector and/or instrument should bemoved to a retracted position.
 3. An augmented surgical applianceaccording to claim 1, wherein said controller comprises software forholding an effector and/or instrument associated with said surgical unitin a position at which the effector and/or instrument was located uponreceipt of an indication by an operator of said second interface unitthat the effector and/or instrument should be held in position.
 4. Anaugmented surgical appliance according to claim 1, wherein saidcontroller comprises software for maintaining an effector associatedwith said surgical unit remain in the condition in which the effectorand/or instrument was upon receipt of an indication by an operator ofsaid second interface unit that the effector and/or instrument should beheld in said condition.
 5. A method for utilizing an augmented surgicalappliance having a surgical unit, a controller unit for controlling saidsurgical unit; and at least a first and a second interface unit, saidfirst and second interface units providing force feedback signals to anoperator of said interface units, comprising the steps of: communicablyconnecting said first and said second interface units to saidcontroller; communicably connecting said surgical unit to saidcontroller; transferring control of said surgical unit to said firstinterface unit; initiating a surgical procedure utilizing said surgicalunit; receiving from an operator of said second interface an instructionto transfer control of said surgical unit from said first interface unitto said second interface unit; transferring control of said surgicalunit to said second interface unit when an instruction to transfercontrol of said surgical unit from said first interface unit to saidsecond interface unit is received; and continuing said surgicalprocedure.
 6. A method for utilizing an augmented surgical applianceaccording to claim 5, further comprising the steps of: receiving from anoperator of said second interface an instruction to transfer control ofsaid surgical unit back to said first interface unit after control ofsaid surgical unit has been transferred to said second interface unit;and transferring control of said surgical unit to said second interfaceunit when an instruction to transfer control of said surgical unit fromsaid first interface unit to said second interface unit is received. 7.A method for utilizing an augmented surgical appliance according toclaim 5, further comprising the step of receiving from an operator ofsaid second interface unit an instruction to move an effector and/orinstrument associated with said surgical unit to a retracted positionupon receipt of an indication by an operator of said second interfaceunit that the effector and/or instrument should be moved to a retractedposition.
 8. A method for utilizing an augmented surgical applianceaccording to claim 5, further comprising the step of receiving from anoperator of said second interface unit an instruction to hold aneffector and/or instrument associated with said surgical unit in aposition at which the effector and/or instrument was located uponreceipt of an indication by an operator of said second interface unitthat the effector should be held in position.
 9. A method for utilizingan augmented surgical appliance according to claim 8, further comprisingthe step of receiving from an operator of said second interface unit aninstruction to maintain an effector and/or instrument associated withsaid surgical unit in the condition in which the effector and/orinstrument was upon receipt of an indication by an operator of saidsecond interface unit that the effector and/or instrument should be heldin said condition.
 10. A computer readable media, which when executed bya computer implements a process providing control functionality to anaugmented surgical appliance, said surgical appliance having at leastone surgical unit, a controller for controlling said at least onesurgical unit, said controller further generating control signals for anoperator interface unit for providing force and positioning feedback,and at least a first and a second operator interface unit, said firstand second operator interface units providing force feedback signals toan operator of said operator interface units, said process comprisingthe steps of: transferring control of said surgical unit to said firstoperator interface unit; receiving from an operator of said secondoperator interface unit an instruction to transfer control of saidsurgical unit from said first operator interface unit to said secondoperator interface unit; transferring control of said surgical unit tosaid second operator interface unit when an instruction to transfercontrol of said surgical unit from said first operator interface unit tosaid second operator interface unit is received; and continuing saidsurgical procedure.
 11. A computer readable media according to claim 10,wherein said process when executed further comprises the steps of:receiving from an operator of said second operator interface aninstruction to transfer control of said surgical unit back to said firstoperator interface unit after control of said surgical unit has beentransferred to said second operator interface unit; and transferringcontrol of said surgical unit to said second operator interface unitwhen an instruction to transfer control of said surgical unit from saidfirst operator interface unit to said second operator interface unit isreceived.
 12. A computer readable media according to claim 10, whereinsaid process when executed further comprises the step of receiving froman operator of said second operator interface unit an instruction tomove an effector and/or instrument associated with said surgical unit toa retracted position upon receipt of an indication by an operator ofsaid second operator interface unit that the effector and/or instrumentshould be moved to a retracted position.
 13. A computer readable mediaaccording to claim 10, wherein said process when executed furthercomprises the step of receiving from an operator of said second operatorinterface unit an instruction to hold an effector and/or instrumentassociated with said surgical unit in a position at which the effectorand/or instrument was located upon receipt of an indication by anoperator of said second operator interface unit that the effector and/orinstrument should be held in position.
 14. A computer readable mediaaccording to claim 13, wherein said process when executed furthercomprises the step of receiving from an operator of said second operatorinterface unit an instruction to maintain an effector and/or instrumentassociated with said surgical unit in the condition in which theeffector and/or instrument was upon receipt of an indication by anoperator of said second operator interface unit that the effector and/orinstrument should be held in said condition.
 15. An augmented surgicalappliance comprising: a plurality of surgical units, said surgical unitseach comprising at least one effector for applying a surgical tool to apatient's tissue; at least one controller unit; and an interface unit,said interface unit having a plurality of hand controllers for receivingpositioning inputs from an operator, said interface unit furtherproviding force feedback signals to an operator of said interface unit,wherein said plurality of surgical units are communicably connected tosaid controller; wherein said interface unit is communicably connectedto said controller; and wherein said controller comprises software fortransforming input received from said interface unit into controlsignals communicable to said surgical units, and wherein said softwarefurther comprises functionality to allow an operator to associatedesired effectors with desired hand controllers.
 16. An augmentedsurgical appliance according to claim 15, wherein said software receivesan indication from said operator that an effector and/or instrumentassociated with a surgical unit should be fixed in position when theeffector and/or instrument is no longer associated with a handcontroller.
 17. An augmented surgical appliance according to claim 15,wherein said software receives an indication from said operator that aneffector and/or instrument associated with a surgical unit should bemoved to a retracted position when the effector and/or instrument is nolonger associated with a hand controller.
 18. A method for utilizing anaugmented surgical appliance having more effectors than handcontrollers, comprising the steps of: providing an interface unit, saidinterface unit having at least one hand controller, said hand controllerreceiving positioning commands from an operator of said interface unitand providing force and positioning feedback to said operator; providingat least one surgical unit, said at least one surgical unit having aplurality of effectors, said plurality of effectors having at least onemore effector than hand controllers; providing a controller unit forreceiving positioning commands from said interface unit and forgenerating control signals for said plurality of effectors, saidcontroller unit further generating control signals for said interfaceunit for providing force and positioning feedback; communicablyconnecting said interface unit to said interface unit; communicablyconnecting said surgical unit to said controller; transferring controlof said surgical unit to said interface unit; receiving from an operatorof said interface unit information identifying desired associationsbetween said at least one hand control and said effectors, saidassociation identifying a single effector to be associated with a givenhand controller; initiating a surgical procedure utilizing said surgicalunit; receiving from said operator a new desired association betweensaid at least one hand control and said effectors, said associationidentifying a single effector to be associated with a given handcontroller; and continuing said surgical procedure.
 19. A method forutilizing an augmented surgical appliance according to claim 18, whereinsaid step of receiving from said operator a new desired associationfurther comprises determining from said operator whether said operatordesires to have a deselected effector move to a retracted position. 20.A method for utilizing an augmented surgical appliance according toclaim 18, wherein said step of receiving from said operator a newdesired association further comprises determining from said operatorwhether said operator desires to have a deselected effector remain inthe position in which the effector was when deselected.
 21. A method forutilizing an augmented surgical appliance according to claim 20, whereinsaid step of receiving from said operator a new desired associationfurther comprises determining from said operator whether said operatordesires to have a deselected effector remain in the condition in whichthe effector was when deselected, wherein said condition defines an openor closed parameter.
 22. A computer readable media, which when executedby a computer implements a process providing control functionality to anaugmented surgical appliance, said surgical appliance having aninterface unit, said interface unit having at least one hand controller,said hand controller receiving positioning commands from an operator ofsaid interface unit and providing force and positioning feedback to saidoperator, said surgical appliance further having a surgical unit, saidfirst surgical unit having a plurality of effectors, said plurality ofeffectors having at least one more effector than hand controllers, saidsurgical appliance further having a controller unit for receivingpositioning commands from said interface unit and for generating controlsignals for said plurality of effectors, said controller unit furthergenerating control signals for said interface unit for providing forceand positioning feedback, said process comprising the steps of:transferring control of a surgical unit to an interface unit; receivingfrom an operator of said interface unit information identifying desiredassociations between said at least one hand control and said effectors,said association identifying a single effector to be associated with agiven hand controller; initiating a surgical procedure utilizing saidsurgical unit; and receiving from said operator a new desiredassociation between said at least one hand control and said effectors,said association identifying a single effector to be associated with agiven hand controller.
 23. A computer readable media according to claim22, wherein said step of receiving from said operator a new desiredassociation further comprises determining from said operator whethersaid operator desires to have a deselected effector move to a retractedposition.
 24. A computer readable media according to claim 22, whereinsaid step of receiving from said operator a new desired associationfurther comprises determining from said operator whether said operatordesires to have a deselected effector remain in the position in whichthe effector was when deselected.
 25. A computer readable mediaaccording to claim 24, wherein said step of receiving from said operatora new desired association further comprises determining from saidoperator whether said operator desires to have a deselected effectorremain in the condition in which the effector was when deselected,wherein said condition defines an open or closed parameter.
 26. Anaugmented surgical training appliance comprising: a surgical unit; acontroller unit for controlling said surgical unit; a first interfaceunit, said first interface unit receiving positioning commands from anoperator of said unit and providing force feedback signals to saidoperator of said interface unit, said interface unit further beingcommunicably connected to said controller; and at least one interfacerepeater unit, said interface repeater unit communicably connected tosaid controller, said interface repeater unit repeating positioningcommands from said operator of said first interface unit, wherein, saidsurgical unit is communicably connected to said controller.
 27. Anaugmented surgical training appliance according to claim 26, whereinsaid first interface unit further comprises a visual display for saidoperator, said visual display displaying parameters associated withutilization of said surgical unit, and wherein said repeater unitfurther comprises a repeater visual display, said repeater visualdisplay repeating said visual display for said operator.
 28. Anaugmented surgical training appliance comprising: a controller unit forcontrolling a surgical unit; a first interface unit, said firstinterface unit receiving positioning commands from an operator of saidunit and providing force feedback signals to said operator of saidinterface unit, said interface unit further being communicably connectedto said controller; and a simulation generator, said simulationgenerator for modeling response parameters associated with positioningcommands received from said first interface unit; wherein saidsimulation generator communicates response parameters associated withsaid positioning commands to said controller, and wherein saidcontroller controls force feedback signals presented to an operator ofsaid first interface unit in accordance with said response parameters.29. An augmented surgical training appliance according to claim 28,further comprising a kinematics model, said kinematics model formodeling dynamic response parameters associated with said positioningcommands.
 30. An augmented surgical training appliance according toclaim 28, further comprising a display generator, said display generatorfor generating a visual signal comporting with a simulated surgicalsubject and said positioning commends, said display generator furthergenerating a simulated visual display and transmitting said visualdisplay to said first interface unit.
 31. An augmented surgical trainingappliance according to claim 30, further comprising at least oneinterface repeater unit, said interface repeater unit communicablyconnected to said controller, said interface repeater unit repeatingpositioning commands from said operator of said first interface unit.32. An augmented surgical training appliance according to claim 31wherein said at least one interface repeater unit further comprises avisual display for repeating said visual display.
 33. An augmentedsurgical appliance comprising: a controller unit for controlling aplurality of surgical units; a first interface unit, said firstinterface unit receiving positioning commands from an operator of saidfirst interface unit and providing force feedback signals to saidoperator of said first interface unit, said first interface unit furtherbeing communicably connected to said controller; a first surgical unit,said first surgical unit having at least one moveable effector, saidfirst surgical unit being communicably connected to said controller; asecond interface unit, said second interface unit receiving positioningcommands from an operator of said second interface unit and providingforce feedback signals to said operator of said second interface unit,said second interface unit further being communicably connected to saidcontroller; a second surgical unit, said second surgical unit having atleast one moveable effector, said second surgical unit beingcommunicably connected to said controller; wherein said controllerfurther comprises functionality for monitoring the position of aneffector and/or a surgical instrument associated therewith associatedwith said first surgical unit and for monitoring the position of aneffector and/or a surgical instrument associated therewith associatedwith said second surgical unit, and for generating a signal to anoperator of said first and second interface units when the position ofan effector and/or a surgical instrument associated therewith associatedwith said first surgical unit and the position of an effector and/or asurgical instrument associated therewith associated with said secondsurgical unit interfere with each other.
 34. An augmented surgicalappliance according to claim 33, wherein said controller furthercomprises functionality for determining an expected position of aneffector and/or a surgical instrument associated therewith associatedwith said first surgical unit and for determining an expected positionof an effector and/or a surgical instrument associated therewithassociated with said second surgical unit, said determination being madebased upon the directions of motion of the effector and/or a surgicalinstrument associated therewith associated with said first surgical unitand the effector and/or a surgical instrument associated therewithassociated with said second surgical unit, and for generating a signalto an operator of said first and second interface units when theposition of an effector and/or a surgical instrument associatedtherewith associated with said first surgical unit and the position ofan effector and/or a surgical instrument associated therewith associatedwith said second surgical unit interfere with each other.
 35. Anaugmented surgical appliance according to claim 34, wherein saiddirections of motion further comprise the velocity associated with saidmotions.
 36. An augmented surgical appliance according to claim 35,wherein said signal has a variable intensity, said variable intensityvarying relative to the likelihood of a positional conflict between thedirections of motion of the effector and/or a surgical instrumentassociated therewith associated with said first surgical unit and theeffector and/or a surgical instrument associated therewith associatedwith said second surgical unit, said likelihood being dependant upon theamount of time before such interference.
 37. An augmented surgicalappliance according to claim 35, wherein said controller scales motionof the effectors and/or a surgical instruments associated therewith inresponse to control inputs down when a likelihood of a positionalconflict between the directions of motion of the effector and/or asurgical instrument associated therewith associated with said firstsurgical unit and the effector and/or a surgical instrument associatedtherewith associated with said second surgical unit is detected.
 38. Anaugmented surgical appliance according to claim 37, wherein said motionscaling is variable, and varies relative to the likelihood of apositional conflict between the directions of motion of the effectorand/or a surgical instrument associated therewith associated with saidfirst surgical unit and the effector and/or a surgical instrumentassociated therewith associated with said second surgical unit, saidlikelihood being dependant upon the amount of time before suchinterference.